Soft and hard tissue changes following immediate implant placement and immediate loading in aesthetic zone—a systematic review and meta-analysis

Type I immediate implant placement has its own advantages like reduced treatment time, number of surgeries and post-extraction bone loss, however, the presence of insufficiently keratinized mucosa poses a challenge for flap adaptation and hinders the achievement of primary stability. Additionally, scientific evidence supports the notion that post-extraction bone loss is a natural biological occurrence that can impact the success of treatments. The primary outcome was to find out the hard and soft tissues changes around the implant following immediate placement and immediate loading. The secondary outcome was to record the adverse events post implant placement such as infection during the course of healing and after restoration, implant failure which would include surgical and post restoration, and over- all success and survival rate of implant. A detailed electronic literature search of the articles published in English language was undertaken in October 2023 on online search engines Medline/PubMed and Cochrane databases with no restriction on year of search to include studies on immediate implant placement and loading with a mean follow-up time of at least 1 year. Weighted means of soft and hard tissue changes were obtained by the inverse variance method. A total of 16 studies were included. There was no difference in crestal bone levels in immediate or delayed implant placement with immediate provisionalization in the anterior maxilla. The peri-implant margin remained and no differences in papillary loss was seen when compared to the delayed implant placement cases. Papilla were more stable or showed less recession in flapless approach compared to full thickness flap approach. Among the studies which filled the GAP with bone graft materials, no significant changes were found in the bone level changes. In case of recession, immediate implant placement with provisionalization did result in approximately 1 mm less facial gingival recession compared with that in the group that had a socket graft. Implant related complications occurred more in immediate implant placement and provisionalization compared to delayed group. And almost similar implant success and survival rates were seen in comparison to delayed implant placement groups. Despite the similar implant survival rates observed in comparison to delayed implant placement groups, more long-term studies are necessary to determine the success of immediate implant placement and immediate loading. Special attention has to be given to aesthetic outcomes.